Basics & Diagnosis Archives - PCOS Health Collective

By Dr. Mélanie DesChâtelets, ND. Licensed naturopathic doctor and founder of PMOS Health Collective.

Is this perimenopause, or is it your PMOS (formerly PCOS) acting up? PCOS in perimenopause is one of the most confusing overlaps there is, because both involve irregular cycles, so the usual clues get muddy right when you need them most. If your cycle’s changing, your mood feels unpredictable, your sleep is off, or your libido has quietly disappeared, you’re not imagining it, and you’re not alone. Here’s what actually changes in your late 30s and 40s, what to track when the cycle clues are hidden, and the questions to bring to your provider.

One quick note first. This is education, not medical advice, and I’m not your naturopathic doctor. Read it, take notes, then bring it to your own care team.

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In this article

What perimenopause actually means
It’s not just low estrogen
The common symptoms (and the caveat)
Why PCOS makes it trickier
What to track when cycle clues are hidden
Why it’s worth paying attention now

What perimenopause actually means

Perimenopause is the transition around menopause, before and the early after. A distinction worth getting straight: menopause itself is a single day, your last menstrual period. We can’t confirm it was the last one until 12 months have passed, so it’s diagnosed retroactively. Everything after that day is postmenopause. “Perimenopause” covers all the change leading up to it, the day itself, and that early postmenopausal stretch. The takeaway: most women are in perimenopause before they realize it, and this phase can last years.

A rough staging helps. Early transition is when cycles start differing by seven or more days fairly regularly (not a one-off). Late transition is when intervals stretch past 60 days. Then the final period, with early postmenopause as the first two years after. Cycle length is one of the key indicators, which is exactly where PCOS complicates things.

It’s not just low estrogen

This surprises people. We tend to picture the whole transition as estrogen deficiency, but early on it’s often the opposite: high and erratic estrogen, with ovulation that doesn’t always happen, or doesn’t happen well. Without reliable ovulation you make less progesterone, so the balance shifts. The deficiency part, where estrogen actually falls, shows up later in postmenopause, once the ovaries retire from that job. So early perimenopause and late perimenopause can feel like two different animals.

The common symptoms (and the caveat)

The common ones: irregular periods, mood swings, irritability, low mood, hot flashes and night sweats, low libido, vaginal dryness or urinary urgency, and insomnia or broken sleep. Here’s the caveat, though. These overlap with other things, like thyroid issues, low iron, or plain burnout. So this isn’t a “self-diagnose from a symptom list” situation, especially if your cycle length is already hard to read with PCOS. We still listen to the symptoms, we just stay careful and rule the other causes out first.

Why PCOS makes it trickier

Because perimenopause and PCOS both involve irregular cycles, you can’t always track the transition by cycle length the way someone else might. And if you’re on the pill or have a hormonal IUD, those clues are masked too, so we lean more on symptoms and body awareness, triangulated against the other possible causes.

Here’s a genuinely interesting twist from the research, and the one I most want people to hear: some people with PCOS who struggled with cycle length start having regular cycles for the first time in their late 30s or 40s. And those cycles can be fertile. So please don’t assume you can’t get pregnant just because conceiving was hard before. That one catches people off guard.

What to track when cycle clues are hidden

If you’re not on hormonal contraception, track your cycle length, it still gives a clue (early transition: changes of seven or more days fairly regularly; late transition: stretches of 60-plus days). If you are on the pill or an IUD, track your symptoms instead: new hot flashes, sleep changes, emotional shifts, libido, vaginal dryness. Then bring that to a more nuanced conversation with your provider, where you also rule out thyroid and iron. One more thing worth knowing: there’s a more progressive view (from the team at UBC) that symptoms can begin before any cycle change at all. If your periods haven’t shifted yet but symptoms are affecting your quality of life, that still counts as really early perimenopause, and you still deserve support. We don’t ignore the pattern just because the calendar hasn’t caught up.

Why it’s worth paying attention now

The research is clear that perimenopausal symptoms can hit quality of life, work, and relationships. It’s a big deal, and there are tools that help people feel better. So you don’t have to wait until your cycle officially changes to take it seriously. If you’re struggling now, that’s reason enough to get clarity, and to bring a clear, tracked picture to someone who can help you read it.

Watch the full video: Perimenopause and PCOS: How to Tell Them Apart, and subscribe to my YouTube channel.

Want to go deeper?

For the full step-by-step education, there’s the PCOS Pivot Course, and the PMOS Energy Code is a short challenge for the energy and fatigue piece.

In BC? A free Clarity Call is a short, no-pressure fit chat, not a medical visit.

This article is educational, not medical advice or a diagnosis. If something here resonates, bring it to your healthcare team, who can look at it through the lens of your individual health.

Main references

Teede HJ, et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023. PubMed
The Menopause Society. Menopause Practice: A Clinician’s Guide. 6th ed. The Menopause Society

By Dr. Mélanie DesChâtelets, ND. Licensed naturopathic doctor and founder of PMOS Health Collective.

If you’ve gone looking for an insulin resistance test after a PMOS (formerly known as PCOS) diagnosis, you’ve probably hit a frustrating wall: you can have a completely normal set of labs and still have insulin resistance. You start reading about blood sugar and insulin, you ask which test to run, and you find out there isn’t one clean answer. So let’s talk about what these labs actually show, and why a normal result doesn’t always rule insulin resistance out.

Quick scope note first. Everything here is about metabolic insulin resistance. I’m not talking about type 1 or autoimmune (LADA) diabetes, where the immune system attacks the pancreas, which is a different mechanism and a different conversation entirely. If that’s your situation, this isn’t the piece for you.

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In this article:

Can normal labs still miss insulin resistance?
Is there a single insulin resistance test?
Fasting insulin, glucose, and HOMA-IR: what do they show?
What does the oral glucose tolerance test (OGTT) tell us?
Can a cholesterol panel hint at insulin resistance?
Why don’t the guidelines routinely recommend an insulin resistance test?
So which insulin resistance test should I actually ask about?

Why a normal lab result doesn’t rule insulin resistance out

This is the part worth slowing down on. I keep coming back to the image of a foggy glass: the view can be cloudy in your labs and the thing is still sitting there, quietly shaping how your body handles sugar. HbA1c is where this trips people up most. It can land squarely in the normal range and still not clear you, because it’s an average of your blood sugar over months, and blood sugar is usually the last domino to fall. Your insulin can be doing overtime to hold that number steady for a long stretch before the number itself ever moves.

It also doesn’t always announce itself. Some people have no symptoms at all. Others notice quieter things, an afternoon slump, feeling off after a meal, cravings that won’t quit. None of those point only to insulin resistance, so they’re clues, not proof, but they’re worth not brushing aside.

Is there a single insulin resistance test?

Not really, and that’s genuinely one of the tricky parts. For type 2 diabetes and glucose intolerance, we have clean diagnostic cut-offs. For insulin resistance, the definitions and cut-offs are more variable, to the point where different studies use different ones. So no single insulin resistance test gives a clean yes-or-no. A few can give us a flavour, as long as we hold them with the right context.

Here’s what’s going on underneath, before any lab gets involved. Eat a meal with a well-tuned system and your blood sugar rises and settles with barely any fuss. With insulin resistance, the job still gets done, but your body has to call in a much bigger crew of insulin workers to move the same meal. That extra backstage effort is the thing these labs are trying to pick up.

Fasting insulin, glucose, and HOMA-IR: what do they show?

Fasting insulin and fasting glucose, and the HOMA-IR score that pairs them, hint at how hard your body is working behind the scenes. The catch is reproducibility: a HOMA-IR isn’t a stable number. Where you got it drawn, and what you did in the days before, can nudge the result, and researchers don’t even agree on one cut-off. So I read any single score loosely. With the right context it can still tell you, in a ballpark way, whether a lot of insulin is getting recruited to do the job or whether your body is handling it efficiently.

What does the oral glucose tolerance test (OGTT) tell us?

The OGTT gives your body a measured dose of sugar and watches the 2-hour response. That little stress-test is how you catch glucose intolerance a resting snapshot would walk right past, the kind that only shows once the system is pushed (it’s the same test a lot of people remember from pregnancy). Out of all of these, the OGTT is the one the PMOS · PCOS guidelines actually recommend, and at specific moments: at diagnosis for someone in a larger body, when conception is on the table, and through pregnancy.

Can a cholesterol panel hint at insulin resistance?

Sometimes, in a roundabout way. If you’ve had a cholesterol panel done, the ratio of your triglycerides to your HDL is worth a glance, because a higher ratio has been linked with insulin resistance. It’s indirect and it’s nobody’s diagnostic line in the sand, but when that panel is already in your chart, it’s a free extra clue.

Why don’t the guidelines routinely recommend an insulin resistance test?

It comes back to that reproducibility problem. Across a big research population the noise averages out and a trend appears. In one individual, a single insulin score has to be held loosely, because timing and the lab can move it. So the guidelines lean on the OGTT at specific moments instead of routine insulin testing.

Where I land is a little softer than that: at this stage we’re usually talking about lifestyle rather than medication, so a slightly imperfect lab can still earn its place for the right person, as long as we’re both clear on what it can and can’t say and it isn’t going to send you into a spin. For some people, just seeing something on paper is what helps, because it makes the invisible visible.

So which insulin resistance test should I actually ask about?

The honest answer is that it depends on your own pattern, and no one number settles it on its own. Each lab above gives a real hint, but it’s a flavour, not a verdict, and the best next move is a conversation with your own healthcare provider, who can read them through the lens of your individual health. What I can do here is get you walking into that conversation knowing what each test is, what it can and can’t tell you, and which questions are worth asking.

Watch the full video: PCOS and Insulin Resistance: Even with “Normal” Labs?, and subscribe to my YouTube channel so the next one finds you.

Want the lab lingo in plain English?

I made a cheat sheet to go with this video, Labs & Lingo: The Blood Sugar Edition. It puts the blood-sugar labs and the lingo (HOMA-IR, fasting insulin, OGTT, all of it) into plain English, so you understand what each test actually measures and can ask better questions at your next appointment. It lives as a YouTube bonus inside Shift Society, my community for women navigating PMOS (formerly PCOS) and metabolic health. If that’s you, join and head to the classroom to grab it.